Short Wave - 988: An Alternative To 911 For Mental Health

Episode Date: August 29, 2022

People experiencing a mental health crisis have a new way to reach out for help in the U.S. — calling or texting the numbers 9-8-8. Today, health correspondent Rhitu Chatterjee joins Scientist in Residence Regina G. Barber to talk about how the hotline works, the U.S. mental health system and what this alternative to 911 means for people in crisis.Further Reading:- The new 988 mental health hotline is live. Here's what to know- Social Media Posts Criticize the 988 Suicide Hotline for Calling Police. Here's What You Need to KnowBelow is a non-comprehensive list of other hotlines and resources from our colleague Aneri Pattani at Kaiser Health News. Some resources may geographically limit services.- BlackLine is a hotline geared toward the Black, Black LGBTQ+, brown, Native, and Muslim communities- Kiva Centers offers daily online peer support groups- M.H. First Oakland and M.H. First Sacramento operate during select weekend hours in the California cities of Oakland and Sacramento- Peer Support Space hosts virtual peer support groups twice a day Monday through Saturday- Project LETS provides support by text for urgent issues that involve involuntary hospitalization- Samaritans of New York is a hotline based in New York City- Trans Lifeline is a hotline for trans and questioning individuals- Wildflower Alliance has a peer support line and online support groups focused on suicide preventionFollow Short Wave on Twitter @NPRShortWave. You can email us at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hi everyone. Regina Barber here. There's a new three-digit hotline that launched this summer, 988. That's the new suicide and crisis lifeline intended for anyone experiencing a suicidal or any other kind of mental health emergency. People can call or text the number. And here to tell us more about this new number is NPR health correspondent, Ritu Chatterjee. Hey, Regina. So, yeah, this new number is a big number.

deal for mental health care in this country. First of all, it's short, easy to remember and dial during emergencies, you know, just like 911. And the hope is that the number will also make it easier to connect people in crises to the right kind of mental health care. Here's how psychologist Ben Miller of the Well-Being Trust described 988 to me. It's truly, I think, the Trojan horse for mental health reform because it forces multiple parts of our system to have a new way to handle individuals that are experiencing a mental health crisis. So today, 988, how does it work? And will it change our mental health system to better respond to people in crisis?

I'm Regina Barber. You're listening to Shortwave from NPR. So, Reto, as you said, 988 is easy to remember and dial. But how will it reform the mental health system? So to understand that, we have to step back a little, Regina. So let's talk about what were the options for people experiencing a mental health crisis before this. Yeah, you could try to find a therapist. There were hotlines. Talk to your health care provider.

I don't know, actually. Yeah, so there weren't that many options. Now, a growing number of people had been calling the 10-digit suicide prevention lifeline since it launched in 2005, which, by the way, now connects to 988 as well. And both these lines are run by the same nonprofit, vibrant emotional health. But really, the vast majority of people experiencing a mental or emotional crisis. have had no option but to dial 911. Really? So did 911 actually connect them to what they needed? Yeah. So when someone dialed 911, their best case scenario is that they would end up in an ER.

And if they were lucky, they would get some care for the immediate crisis after probably waiting for hours, if not days. But when they get back home, they rarely ever had any follow-up care options as one might with physical. health problems. But the worst case scenario with 911 is that they end up interacting with law enforcement, which sadly often ended in tragedy and trauma. Here's Ben Miller again. And if you look at the data from the police, it's about 20% of their total staff time is spent responding and transporting individuals who are experiencing a mental health crisis. And just last year, he says more than 2 million people with serious mental illnesses ended up in jail. And a lot of people with mental illness tragically get killed by life.

enforcement. Exactly. In fact, a quarter of all police shootings involve people with mental illness or a substance use disorder. And people of color are more likely to be victims of those shootings too. Yeah. The shootings disproportionately affect black and brown people. People like Miles Hall, a young man in Walnut Creek in California, who had been diagnosed with schizoaffective disorder. His mother, Tarn Hall, says Miles was a really gentle guy, even when he was having delusions. He was just a great kid. You know, he'd walk in a room and he'd have this infectious smile and he was just a beautiful soul. Tom says that Miles' delusions made him think he was Jesus, so he'd go around knocking on people's doors, preaching to them. And because the family is

African-American, Tahn had been worried about her son's safety, especially because they live in a predominantly white neighborhood. And she'd taken the extra precaution of telling the police ahead of time about her son's condition soon after he was diagnosed. So they wouldn't accidentally shoot him or attack him? Yeah. But one day in June 2019, Miles was in the midst of a breakdown and the family called 911. I'm telling them Miles isn't a mental health emergency.

We need help. We need the ambulance. And, you know, I have to point out that the family had on prior occasion being able to get Miles to the hospital with the help of the police. And this time, too, Ton spoke with the mental health officer at this police station. mental health officer recognized Tahn, and she reassured her that she was going to be on her way soon. But before this officer could get there, other cops did. Right when they got on scene within 30 seconds, they're shouting his name.

You don't do that when someone's in a having delusions and hallucinations. And then within 30 seconds, one of them shot a beam bag. And then within like another second, they were shooting their guns. Miles was shot four times. And Miles died that day. This is heartbreaking. Yeah. I had a false expectation that somehow, you know, if law enforcement knew him and they knew he just had a mental health condition that he would be treated with compassion and he would be treated with care and that he wouldn't be gunned down.

And so Tahn and many others like her hope that, you know, this number is a safer, more effective alternative to 911 because it would connect callers or text us to professionals, who are specifically trained to address mental health crises, who can then, you know, work with the individual to de-escalate the situation and for individuals who need additional services, additional supports, the counselors at the 98-call centers can connect them to those services. So what kind of services are we talking about? Things like mobile crisis teams with mental health professionals that could go to people's homes. We're talking about behavioral urgent care centers.

And some parts of the country already have these services. Take, for example, Portland, Oregon. That's where Angela Kimball's son was living. He'd been diagnosed with bipolar disorder. And in 2017, Angela says he had a major manic episode. He'd ripped out all the kitchen cabinets. He'd smashed the stove into just nothing. He was talking about how soap was poison and how he felt like he was being surveilled.

So Angela reached out to the... the local crisis center and they sent a mobile crisis team to her son's house. They talked very respectfully and kindly to my son and they just said, hey, Alex, we hear that you haven't been sleeping for a few days. Looks like things aren't going well for you. How are you doing? He says, yeah, I can't go to sleep. You know, my head is hurting and I just want to fall asleep. And then the lead clinician said, you know, Alex, I know a hospital with a doctor who would definitely be able to help you get to sleep and help your head stop hurting. How's that sound to you? And Angela says, you know, her son willingly went with the team to a crisis stabilization unit where he received treatment right away.

Wow. I mean, that's the kind of care you hope everyone in crisis can receive. But would you say that a month and a half since its launch has 988 connected callers across? the country did the kind of care Angela's son received? Short answer, Regina, is no. But the long answer is that it depends on where you live. So right now, we have more than 200 call centers across the country that make up the 988 network. And while it's a national system and the federal government in the past year has invested historic levels of funding into 988, this network primarily functions as a locally or

state-run system. So when someone calls, first of all, they're connected to a counselor at a local call center, closest to their area code. And mind you, for the vast majority of callers, the call and the chat with a trained mental health counselor is itself helpful at de-escalating the crisis. Right. But some callers will need additional support and services, right? Yeah. But whether those services are available or not depends on people's zip code. whether a state has invested money into 988 and into having those additional range of mental health services. Now, more and more states have been adding these services, things like mobile crisis teams in preparation of the 988 launch. But I have to point out that only 14 have passed legislation to fund and support 988 related services, including four states that have added a small fee to people's cell phone bills to fund. to fund 988, just like there's a fee you and I pay every month for 911. But I have to, again, say that the vast majority of states haven't added that fee and don't have any other mechanism to fund 98 and related services.

But advocates like Angela remain hopeful that having this number up and running is a good thing in the long run. It's going to expose all the gaps and weaknesses in our crisis system. And frankly, that can be a good thing because it can also signal here's where we need to make investments as a country, as a state, as a local community. I can't help thinking about all the people like Miles who was killed by cops during a mental health crisis. And then all the people with mental illness who are in jail, is 988 really reducing the chances that somebody in crisis will encounter law enforcement? So we don't have any data on that yet, but we can extrapolate from what we know about calls to the previous 10-digit National Suicide Prevention Lifeline, which, by the way, is essentially the older version of 988. And we know that of all the calls to that number since it launched in 2005, only 2% needed emergency services to be dispatched. And those services could mean a mobile crisis team or the police, depending on where the callers were located.

So if this trend continues with 988, it means only a tiny percentage of colors would interact with police. Yeah, that's the hope. But I also have to add that many people with mental illness and some counselors, too, have raised concerns that 988 could still lead to interaction with law enforcement and also to involuntary hospitalization. And one of our colleagues at Kaiser Health News, which NPR closely works with, did. a story addressing these concerns. The reporter was Anari Patani. And in Anari's story, she points out that it's only when a caller refuses to cooperate with a counselor on the phone in keeping themselves safe. It's only then that the counselor might involve law enforcement. Okay, so I understand that 988's goal is to have interaction with police be really, really small. But are there any alternatives to calling 988? What if somebody

still hesitant or concerned that cops will come to their door? Sure. People can reach out to peer support lines. These are hotlines that are run by people with lived experience of mental illness. And we link to some of those hotlines on our show notes. Yes, do check out our show notes. And overall, it sounds like 98 is mostly a safe bet for anyone in a mental health crisis. But again, it will take a while for the system to fully develop to the point where every caller anywhere in the country is connected to help and additional services were needed right away. Read to Chatterjee, thank you for sharing your reporting on this topic with us.

Always a pleasure, Regina. This episode was produced by Thomas Liu, edited by Rebecca Ramirez and fact-checked by Burley McCoy. The audio engineer was Josh Newell. Giselle Grayson is our senior supervising editor. Andrea Kisick is the head of the science desk. Terence Samuel is the vice president and executive editor. Edith Chapin is the vice president and executive editor at large,

and Nancy Barnes is our senior vice president of news. I'm Regina Barber. Thanks for listening to Shortwave, The Daily Science Podcast from NPR.